Important V5010 Reminders for Electronic Claim Submitters
It is important to watch the electronic commerce alerts for news and updates related to electronic data interchange transactions. See below for a quick summary of recently posted electronic commerce alerts. If you utilize a billing service or clearinghouse to conduct electronic transactions on your behalf, please ensure they are aware of this information as well.
Billing Provider Address, Loop 2010AA
All HIPAA-standard electronic transactions submitted by covered entities must now be exchanged using the ANSI Version 5010 standards. The ANSI v5010 Technical Reports Type 3 (TR3s) specify that the Billing Provider Address must be a physical street address. P.O. Box or Lock Box addresses may only be submitted as the Pay-to Address (Loop ID-2010AB). This applies to all claim formats, i.e., Dental, Institutional and Professional (ANSI 837D, 837I and 837P).
Valid 9-digit ZIP Code (ZIP+4) Required
A valid 9-digit ZIP code is required in the billing address and service facility location (if different from billing). A 9-digit ZIP code is not required in any other address field; however, if a 9-digit ZIP code is entered, it must be valid, otherwise the claim will reject.
NPI – Get it, share it, use it!
Your NPI and other provider information should be reported consistently across all payers. For example, when billing Blue Cross and Blue Shield of New Mexico (BCBSNM), it is important to use the same NPI and address that was used when billing Medicare. To help ensure that your BCBSNM claims are properly processed and payments are sent to the correct location, the correct NPI(s) and other information must be on our provider file. This includes the rendering NPI, when applicable.